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Analysis of the Anatomic Changes of the Aging Facial Skeleton Using Computer-Assisted Tomography

Richard, Michael J. M.D.*; Morris, Carrie M.D.*; Deen, Byron F. M.D.*; Gray, Linda M.D.; Woodward, Julie A. M.D.*

Ophthalmic Plastic & Reconstructive Surgery: September-October 2009 - Volume 25 - Issue 5 - p 382-386
doi: 10.1097/IOP.0b013e3181b2f766
Original Article

Purpose: The bony skeleton serves as the scaffolding for the soft tissues of the face; however, age-related changes of bony morphology are not well defined. This study sought to compare the anatomic relationships of the facial skeleton and soft tissue structures between young and old men and women.

Methods: A retrospective review of CT scans of 100 consecutive patients imaged at Duke University Medical Center between 2004 and 2007 was performed using the Vitrea software package. The study population included 25 younger women (aged 18–30 years), 25 younger men, 25 older women (aged 55–65 years), and 25 older men. Using a standardized reference line, the distances from the anterior corneal plane to the superior orbital rim, lateral orbital rim, lower eyelid fat pad, inferior orbital rim, anterior cheek mass, and pyriform aperture were measured. Three-dimensional bony reconstructions were used to record the angular measurements of 4 bony regions: glabellar, orbital, maxillary, and pyriform aperture.

Results: The glabellar (p = 0.02), orbital (p = 0.0007), maxillary (p = 0.0001), and pyriform (p = 0.008) angles all decreased with age. The maxillary pyriform (p = 0.003) and infraorbital rim (p = 0.02) regressed with age. Anterior cheek mass became less prominent with age (p = 0.001), but the lower eyelid fat pad migrated anteriorly over time (p = 0.007).

Conclusions: The facial skeleton appears to remodel throughout adulthood. Relative to the globe, the facial skeleton appears to rotate such that the frontal bone moves anteriorly and inferiorly while the maxilla moves posteriorly and superiorly. This rotation causes bony angles to become more acute and likely has an effect on the position of overlying soft tissues. These changes appear to be more dramatic in women.

Age- and gender-related changes of the craniofacial skeleton occur throughout life.

*Division of Oculoplastic and Reconstructive Surgery, Department of Ophthalmology and †Division of Neuroradiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina, U.S.A.

Accepted for publication February 18, 2009.

Presented as abstract at the 2007 Fall ASOPRS Symposium, November 8–10, New Orleans, LA, U.S.A.

The authors have no financial or proprietary interests related to this manuscript.

Address correspondence and reprint requests to Michael Richard, M.D., Duke University Medical Center, DUMC Box 3802, Durham, NC 27710, U.S.A. E-mail:

©2009The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.